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29.09.2023 | Original Communication

Alemtuzumab induces severe orbitopathy in relapsing–remitting multiple sclerosis

verfasst von: Pablo Rodríguez de Vera Gómez, Mariola Méndez Muros, Alberto Torres Cuadro, Francisco Javier Toyos Sáenz de Miera, Rocío López Ruiz, Raquel Guerrero Vázquez, Juan Jesús García González, Antonio Manuel Garrido Hermosilla, Tomás Martín Hernández

Erschienen in: Journal of Neurology | Ausgabe 1/2024

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Abstract

Context

Treatment with Alemtuzumab (ALZ) in patients with Relapsing–Remitting Multiple Sclerosis (RRMS) is associated with the development of ALZ-induced Graves' disease (GD-ALZ). Some cases may develop associated Graves´ Orbitopathy (GO-ALZ), with possible visual compromise.

Aim

The aim of this study was to describe the main clinical and biochemical characteristics of GD-ALZ, as well as the clinical course of a case series of GO-ALZ

Methods

This study is a retrospective observational study, carried out in a reference hospital for the care of patients with RRMS in Spain. Cases treated with ALZ in the period 2014–2022 were included. GO-ALZ cases were identified among those with clinical symptoms compatible with thyroid eye disease after initiating ALZ treatment.

Results

A total of 135 cases, with a mean follow-up of 69.6 months after the first ALZ cycle, were included. The incidence of GD-ALZ was 32.6% (44/135), with a predominance of women (77.3%) and mean age of 41.9 years. The presence of first-degree relatives with hypothyroidism was identified as risk factor for the development of GD-ALZ (adjusted P-value: 0.02). GO-ALZ was diagnosed in 6 cases (incidence: 13.6%), of which 3 had severe clinical forms of GO, requiring anti-IL-6 treatment. A favorable response was reported in all of them, with a significant decrease in disease activity and improvement in proptosis.

Conclusions

We report one of the largest cohorts of GD-ALZ and GO-ALZ cases. The diagnosis of these entities should be taken into account in patients treated with Alemtuzumab, given the risk of developing severe clinical forms. In moderate-severe forms of GO-ALZ, drugs with anti-IL-6 activity are a safe and effective option.

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Titel: Alemtuzumab induces severe orbitopathy in relapsing–remitting multiple sclerosis
verfasst von: Pablo Rodríguez de Vera Gómez
Mariola Méndez Muros
Alberto Torres Cuadro
Francisco Javier Toyos Sáenz de Miera
Rocío López Ruiz
Raquel Guerrero Vázquez
Juan Jesús García González
Antonio Manuel Garrido Hermosilla
Tomás Martín Hernández
Publikationsdatum: 29.09.2023
Verlag: Springer Berlin Heidelberg
Erschienen in: Journal of Neurology / Ausgabe 1/2024
Print ISSN: 0340-5354
Elektronische ISSN: 1432-1459
DOI: https://doi.org/10.1007/s00415-023-11995-6

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